Clinical - Senior LTSS Service Care Manager; RN - J01077

Overview

Job Profile

Summary:

Position

Purpose:

For use by Arizona, Superior, and Sunflower only. Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available to receive appropriate high-quality care.

Requires graduate from an Accredited School of Nursing or a Bachelor's degree and 4–6 years of related experience. Bachelor's degree in Nursing preferred.

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
• NP - Nurse Practitioner - Current State's Nurse Licensure required
• For Superior:
  Resource Utilization Group (RUG) certification must be obtained within 90 days of hire
• For Arkansas Total Care plan - This position is designated safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment (before hire and recurring), and a drug screen (at time of hire and recurring). Must reside in AR or border city. Travel: 5% required

• Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome
• Develops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs
• Coordinates and manages between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
• Monitors care plans / service plans and/or member status, change in condition, and progress towards goals; collaborates with member, caregivers, and providers to revise or update plans as necessary
• Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility
• Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
• Reviews referrals information and intake assessments to develop appropriate care plans / service plans
• Collaborates with healthcare providers to facilitate member services and/or treatments and determine a revised care plan if needed
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines
• Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
• Acts as liaison and member advocate between the member/family, physician, and facilities/agencies
• Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
• May perform home and/or other site visits (e.g., once a month or more) to assess member needs and collaborate with resources
• Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through onboarding to upskill readiness
• May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provide coaching and shadowing opportunities
• May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
• Engages in a collaborative process…